CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $173
Cash Discount Price: $464
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UMass Memorial Healthalliance Hospitals is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $464. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.82x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$464

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $464 (487%)

Insurance Median: $173 (182%)

Cash: $464 (487% of Medicare)

Ins. Median: $173 (182% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Tufts [11201]	$23	24%
Cigna	$25 - $162	26%
Wellpoint [11112]	$42	44%
Workers Compensation [20501]	$66	69%
Harvard Pilgrim [10701]	$118	124%
Champva [11001]	$138	145%
UnitedHealthcare	$151 - $484	159%
Correctional Care [11003]	$162	170%
Institution [10406]	$162 - $257	170%
Medicaid / KanCare	$162 - $252	170%
Medicare (plans)	$162	170%
Tufts Dual [10111]	$162	170%
Tufts Us Family [11203]	$162	170%
Blue Cross Blue Shield	$167	175%
Aetna	$170 - $317	179%
Commonwealth Care Mcr [10115]	$170	179%
Fallon Mcr Supp [20202]	$170	179%
Harvard Pilgrim Mcr [10106]	$170	179%
Mgb Mcr [10124]	$170	179%
Tufts Mcr [10112]	$170	179%
Senior Whole Health [10110]	$173	182%
Tufts Connectorcare [10507]	$275	289%
Hsno/Free Care [10801]	$294	309%
First Health Network [11120]	$333 - $363	350%
Multiplan [11109]	$333 - $363	350%
Connecticare [11105]	$444 - $484	466%
Fallon Carelon Hlth [28]	$444 - $484	466%
Fallon Mcaid Carelon Hlth [29]	$444 - $484	466%
Grants [20507]	$444 - $484	466%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $464.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.